Hi. This is my first time posting on this board. I am 26 y/o female. I have chronic pancreatitis, just diagnosed in May of this year. I've been battling pancreatic problems since June of 2004 though. I've had severe pain since that time. I developed severe acute pancreatitis when i was 34 weeks pregnant, and to make a long story short, every organ in my body failed and I was given a 5% chance of making it, but miraculously I did. Now 7 major abdominal surgeries later, I still get intense pain. For the last year, I have been treated with Dilaudid 4mg as needed, and that works great for me. My PCP was prescribing it. Now he decided that i needed to go to a pain management doc. I had my first appt yesterday. He told me to stop taking dilaudid, and he gave me a new drug, he said it just came out. It is Ultram 200mg, it's an extended release and you take it once a day. Has anyone had any experience with this? They have had me on the regular Ultram before, but it didn't do a thing for me.. I don't get why he wants to change my meds around, when they were working just fine for me... I am a nurse so, i know he is concerned about me taking dilaudid... thinking the hospital may have a problem with me returning to work being on a strong narc like that, but if I am in pain, I won't be able to return to work anyways! Any advice would be greatly appreciated.. Thanks in advance!
Hi & Welcome
I've never heard of the ER Ultram, however, Ultram by itself is a far cry from Dilaudid in terms of pain relief. Ultram isn't a narcotic, although it can be addictive, but Dilaudid is a strong narcotic pain med. I would think at the very least, the PM doc would suggest that you slowly discontinue the Dilaudid to prevent withdrawal, then start taking the ER Ultram.
Some people have great results with Ultram, but IMO, if you are still suffering with pain from chronic pancreatitis, that's a huge change in meds and your not likely to get the same pain relief with the ER Ultram as your getting with the Dilaudid, especially given the fact when you took Ultram before it didn't work.
Do you have more dilaudid left and did the PM doc say you could continue to take it if the ER Ultram doesn't work?
My big concern would be that you might go through withdrawal and then the pain you normally have would be much worse, along with other WD symptoms.
If you find the ER Ultram is ineffective, you may want to ask about percoct or Oxycontin?
The pain management doc didn't tell me to wean down the dilaudid, he just said "don't take it anymore", and to take the ER Ultram. I do have about 20 of the dilaudid pills left, and the doc never asked if I had more or how many I had. I agree I do worry about having some withdrawl from the dilaudid. But most of all, I am so scared to be in that much pain again. I suffered so badly with pain before I was on the dilaudid, I really don't want to go through that again! Does it seem strange that he doesn't want to see me again for 3 months? I thought the norm was to have a visit monthly?
I am shocked that the PM didn't want you to wean off the Dilaudid, but I guess it depends on how often you use it. If your taking it everyday or even every other day, withdrawal is likely to happen and then your pain is going to be much worse.
As far as waiting for three months till your next appt., normally when a PM doc changes/discontinues a med, people are seen in 2-4 weeks for a follow up.
Most of the people who see their PM docs every three months are established patients who have been on their meds for a long time and don't need any changes.
How long has it been since your started the ER Ultram? How often were you taking the Dilaudid?
I started the Ultram ER yesterday. I had been on the dilaudid for a tad over a year, and took it only when absolutely necessary, but it ended up being about once a day, with sometimes skipping a day. On days that I was having a flare-up of the pancreatitis I was counting the minutes until I could take it again though. As it was prescribed I was allowed to take it every 4 hours. I really didn't take it until the pain got to about a 6 on the 1-10 scale, because it makes me a bit drowsy and I have a 2 year old daughter to care for! She doesn't always let me rest.. lol
Ultram (Tramadol) is a synthetic opioid analgesic. Its a unique drug in the sense that it has pain relieving properties and anti-depressant properties. Ultram is not a new drug. Its been around for some time now. However, the ER version is newer. Tramadol has been around since about 1995. The ER came has been out for 9 months or so.
Tramadol is weaker than dilaudid and I'm surprised that your doc didnt give you a taper schedule.
Tramadol works for some and not for others. Due to its anti-d properties, some people have had a hard time getting off the drug when its time. I haven't heard much about the ER version yet, or how well it works. But I have heard of people having trouble getting off Tramadol (Ultram) in the past.
This is a drug that you will definantely need a taper with. It was under estimated when it first came out. Some docs were under the impression that it would not cause dependency or addiction. They soon found out that this was not the case. Point is, just be careful and make sure that when you get off the drug, that you are tapered off it to prevent WD's.
Hopefully it works for you. It is a pretty big decrease from Dilaudid and I would be concerned about just stopping. You may want to talk with your doc about tapering from Dilaudid to prevent WD's.
Keep us posted on how the ER version works for you.
Since you were taking the Dilaudid everyday, look out for the signs of withdrawal, i.e.; abdominal cramps/diarrhea, vomiting, muscle aches, runny nose, increased pancreatic pain, nervousness, insomnia, etc.
If you notice these symptoms or if your general pain becomes much worse, I would call your PM doc and tell him about your pain and ask if you can resume the Dilaudid.
It's good that you have some more left over just in case
The biggest concern I would have is why did your PM doc want you to stop the Dilaudid? It sounds like you were taking it only when absolutely necessary and since you still have pancreatitis, your pain is not going away.
I've read about pancreatitis and I understand it's one of the more painful conditions a person can have and unfortunately, it seems to be chronic.
Just because your a nurse is no reason for a PM doc to want you to stop the narcs. There's alot of nurses that are in PM and on narcs and as you said, you aren't able to work now anyway.
If you find the ER Ultram doesn't work, I would consider finding a new PM doc or at least asking the one you have now to try something else.
Ultram never gave me even 1% relief for my kidney stones.I would be concerned about the info your Dr gave you to be honest. I would get a new PM Dr right away if they Ultram doesnt help. I would also be concerned just stopping the other med.
One more thing, After reading hours on this board and heard all these stories of people suffering, I am just realy sad and shocked. I understand the Dr.'s are scared about addiction, BUT if they have tests and proof of terrible pain a person has, seems the addiction wouldnt matter at that time. If a person is suffering, why should they? If your in terrible pain and have a legitamate illness why are they so afraid? Why are these doctors so scared to help manage peoples pain? They go to school and become doctors to help people. I realy just dont understand. Most of the time people are so under medicated, and they treat people so text book. Its just realy frustrating to me. My PM doctor told me that people who are in bed with terminal illness and are dying are under medicated, and are left to suffer even more for the last few months of death. He said it goes on alot more than people think.
Tramadol (Ultram) is a synthetic analgesic. You're right that it is not a narcotic in the sense that it is not made from Morphine, Codeine, Thebaine or other common opioids. However, Tramadol does bind to u-opioid receptors. Making this drug a unique synthetic analgesic. It also has a weak inhibition of reuptake of norepinephrine and serotonin. So this drug does not only have opioid properties (not morphine, etc) but also anti-depressant properties
Unfortunantely, this drug has been under estimated by some docs in the past. This drug can cause W/D's that can sometimes be worse than standard opiate W/D's. People have reported seizures while coming off this drug.
Tramadol is effective in some and many people report good results. But don't let the "Non-Narcotic" stigma fool anyone with this drug.
This is all listed under the Pharmacodynamics of this drug. It is mandatory that the manufacturer of this drug (ortho-mcneil) has to put out. And actually the first line of under the Clinical Pharmacology say that this drug is a centrally acting synthetic opioid analgesic. However, I agree with you that it is in a different respect.
But as far as it being related to Morphine, Thebaine, or Codeine which most opiates are made from, it is not. So you are right that it is not related directly to any of the above.
I just caution people that have heard of this "non-narcotic" drug and go into it thinking that it is perfectly safe. Again, it is an effective drug for some people just like other pain meds, but it is important for those that are taking it or considering taking it to understand that it has "like narcotic" side effects.
I have taken Tramadol in the past, and for me it didn't work that well. But everyone is different just as in any pain relievers. However, I have read multiple studies of people saying that it works great for them. I have also read studies that suggest it can be as effective as Morphine, but I have my doubts on that one.....
But who knows. I guess thats why we pay scientists so much, LOL
I've been taking Ultram ER for over 8 months and find that it's most effective for me when used with codeine or a stronger opiate if needed. Actually 200mg a day is a debated dose here in the UK. My Primery Doc thought that was the max dose, as it said it was supposed to work with the same effect as 400mg Ultram. Well that's rubbish and me Pain Doc said "maybe for little old ladies," but for chronic pain patients you need to be taking 200mg every 12 hours.
Blasterboy (and everyone else),
Thanks so much for your reply. I've been on this Ultram ER since the 14th now, and to tell you the truth I am not at all impressed with it. I haven't really noticed any prominent withdrawl symptoms from the dilaudid, unless my increased pain level the past 2 days is coming from that. The Ultram doesn't seem to be doing any better than plain old tylenol would do for me. It's so frustrating. I'm going to give it a few more days just to prove to the pain doc that I truly tried this, then I'm gonna call and see what we can try next... whether it's upping the ultram ER or adding something for break through pain.. or just going to something else.. I wish he would have just left things alone.. at least I was comfortable before!!!
He mentioned a few other things while I was there... neurontin (which i was previously on and it didn't do much of anything), TENS unit, cranial sacral PT, lidoderm patches, and fentanyl patches. Does anyone know anything about these working for pancreatic pain? Before I was put on Dilaudid I was on the fentanyl patch, they actually had me on the 100 mcg patch, and it did help... but still the dilaudid seemed to do more..
Augh! what to do?
I was rx'ed Ultram when it first came out. I was not seeing pain management at the time and in fact, I was not dx'ed yet. Doc told me it was like a super asprin and I remember that theh sheet that came with the meds said it was non-narcotic, not addicitive, etc. It did zippo for me and in fact, years later it has been proven that ultram might be more addicitive than narcotics and is harder to get off of.
Years later, was dx'ed with 4 levels of Disc Herniation, 2 levels of Spinal Stenosis, sponylosis, scoleosis and a deformed thecal sac. So I am rx'ed 100mcg Fentanyl patch and 30 mg Roxicodone for bt.